Who pays for medical care at sea?

Under MLC 2006 Reg. 4.1 the shipowner is financially responsible for all medical care of the seafarer including hospitalisation, dental treatment, and necessary medication, until the seafarer is repatriated and during a period of up to 16 weeks after sign-off if the illness or injury was not pre-existing. Standard A4.2.1 sets the financial-security framework so that funds are guaranteed via a P&I cover or alternative.

Can I be repatriated at the shipowner's expense for a medical reason?

Yes. MLC Reg. 2.5 requires repatriation when the seafarer is no longer fit to perform their duties (illness or injury). The shipowner pays for return travel home, medical escort if needed, and continuing wages until the contract end. The decision is made by the master in consultation with the TMAS doctor and (where in port) a shore physician; documented in the OLB.

What if the company refuses to repatriate?

Activate MLC Standard A2.5.2 financial-security mechanism: the insurer named on the DMLC Part II is contractually obliged to fund repatriation. If the company is also delaying, contact the flag state via MLC Standard A5.1.5 complaint procedure, the ITF Inspectorate, ISWAN SeafarerHelp 24/7, and the port-state PSC office. The IMO/ILO Joint Database of Abandoned Seafarers will record the case.

What medical fitness do I need to keep?

STCW Reg. I/9 + MLC Standard A1.2 require a valid medical fitness certificate from an approved doctor. Validity 2 years (1 year for under-18). Standards in the ILO/IMO Joint Guidelines (2013) cover vision (≥6/6 corrected, colour-discrimination tests for deck), hearing, cardiovascular, respiratory, mental health, and substance use.

Can I be denied repatriation if my home country won't let me back?

Repatriation country priority under MLC Standard A2.5.1: (a) country of residence, (b) country of recruitment, (c) other place agreed in the SEA. If the home country is closed (war, sanctions, COVID-era controls), the shipowner remains responsible for repatriation to a safe destination — typically a transit country with onward connection. Ukrainian seafarers since 2022 routinely repatriate via Romania/Poland transit; engage the manning agent early.

Health, repatriation & medical care

MLC 2006 Regulation 4.1 (medical care on board and ashore) and Regulation 2.5 (repatriation) are the backbone of seafarer health protection. Combined with STCW Reg. I/9 (medical fitness) and IMO/ILO/WHO Joint Guidelines (2013), they fix what care you are entitled to, who pays, and how to invoke the system when something goes wrong.

Care entitlement at sea

· Onboard care at no cost from the shipowner. Includes medical attention, supplies from the kit, and access to a TMAS doctor.
· Onshore care at the next port if shipboard treatment is inadequate. The shipowner pays consultations, hospitalisation, surgery, dental treatment for emergencies. The shipboard medical officer documents the referral.
· Continuing care after repatriation — up to 16 weeks of medical care and full wages for non-pre-existing illness/injury (MLC Standard A4.2.1).

Repatriation for medical reasons

1. Master / Medical Officer assesses fitness to continue duties; consults TMAS.
2. If unfit: master enters the assessment and decision in the OLB.
3. Company / DPA notified; manning agent arranges flight + escort if needed.
4. Repatriation under MLC Reg. 2.5 — at no cost to the seafarer; to the country of residence or as agreed in the SEA.
5. Continuing wages until contract end OR until a flag-state-defined period (typically 4 months for cargo ships under Standard A2.5.1).
6. Insurance follow-up: P&I correspondent or shipowner's medical insurer handles continuing-care invoices.

If the company stalls

· DMLC Part II — locate the financial-security certificate posted on board; identify the insurer; contact directly.
· Flag state — MLC Standard A5.1.5 complaint to the flag administration.
· ITF Inspectorate — at the next port; can negotiate quickly via the FoC framework.
· ISWAN SeafarerHelp — 24/7 multilingual triage and connection to local welfare network.
· Port-state PSC — under the Tokyo / Paris / Indian Ocean MoU MLC inspection regimes, PSC can detain the vessel until the seafarer is repatriated.

Medical fitness — STCW + MLC

· Vision: ≥6/6 corrected (Snellen) for deck; colour-discrimination tests (Ishihara plates) for deck only.
· Hearing: ability to hear ordinary speech in one ear at 5 m, the other ear at 2 m.
· Cardiovascular: no uncontrolled hypertension, no recent unstable angina, no high arrhythmia risk.
· Respiratory: adequate FEV1; no recent active TB; no severe persistent asthma.
· Mental health: no condition limiting decision-making in emergencies or fitness to perform safety duties.
· Issued by an approved doctor on the flag state's list. Maximum validity 2 years.

Sources: MLC 2006 Reg. 2.5 + Standard A2.5; MLC Reg. 4.1 + Standard A4.1; MLC Reg. 4.2 + Standard A4.2.1 (financial security 2014 amendments); STCW Reg. I/9; ILO/IMO/WHO Joint Guidelines on Maritime Medical Examinations (2013). See also injury at sea, medical help, repatriation blocking, MLC abandonment.